New conditions: Alzheimer’s Disease & Insomnia

05 Aug New conditions: Alzheimer’s Disease & Insomnia

We are pleased to announce the addition of two new conditions to our TreatGx medication decision support system. Alzheimer’s Disease and Insomnia can now be accessed by all TreatGx users.  

The Alzheimer’s algorithm provides treatment options for adults with mild, moderate, or severe Alzheimer’s disease, and includes guidance on medication titration and switching. Treatment options and dosing are based on the most up-to-date international guidelines from the American Family Physician[1], the National Institute for Health and Care Excellence[2], the BMJ[3], and others[4-6].

The Insomnia treatment algorithm includes medication treatment options for primary insomnia in adults. The medication treatment options are ranked into two lines of therapy according to evidence for efficacy, and each medication includes efficacy information for relevant sleep parameter(s).  The Insomnia algorithm is based on several international guidelines, including those from the American Academy of Sleep Medicine [7], the American College of Physicians [8], the US Department of Veterans Affairs [9], the British Association for Psychopharmacology [10], and the European Sleep Research Society [11], in addition to two large clinical evaluations by CADTH [12] and the AHRQ [13]. 

All medication doses are personalized based on the patient’s kidney function, liver function, drug-gene interactions, drug-drug interactions, drug-condition interactions, and other important patient factors.   

1.Epperly T, Dunay MA, Boice JL: Alzheimer Disease: Pharmacologic and Nonpharmacologic Therapies for Cognitive and Functional Symptoms. American family physician 2017, 95(12):771-778. 

2.National Institute for Health and Care Excellence: Dementia: Assessment, management and support for people living with dementia and their carers. In: National Institute for Health and Care Excellence (UK). London:; 2018. 

3.Joe E, Ringman JM: Cognitive symptoms of Alzheimer’s disease: clinical management and prevention. BMJ (Clinical research ed) 2019, 367:l6217. 

4.Moore A, Patterson C, Lee L, Vedel I, Bergman H: Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: recommendations for family physicians. Canadian family physician Medecin de famille canadien 2014, 60(5):433-438. 

5.Cummings JL, Isaacson RS, Schmitt FA, Velting DM: A practical algorithm for managing Alzheimer’s disease: what, when, and why? Annals of clinical and translational neurology 2015, 2(3):307-323. 

6.Fink HA HL, Linskens EJ, et al,: Diagnosis and Treatment of Clinical Alzheimer’s-Type Dementia: A Systematic Review In. Edited by (US) AfHRaQ, vol. (Comparative Effectiveness Review, No. 223.). Rockville (MD); 2020. 

7.Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL: Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017, 13(2):307-349. 

8.Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD, Physicians ftCGCotACo: Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine 2016, 165(2):125-133. 

9.Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C, Sall J: The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Annals of internal medicine 2020, 172(5):325-336. 

10.Wilson S, Anderson K, Baldwin D, Dijk DJ, Espie A, Espie C, Gringras P, Krystal A, Nutt D, Selsick H et al: British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol 2019, 33(8):923-947. 

11.Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia-Borreguero D, Gjerstad M, Goncalves M et al: European guideline for the diagnosis and treatment of insomnia. Journal of sleep research 2017, 26(6):675-700. 

12.Clinical Evaluation of Interventions for the Management of Insomnia: A Review of Reviews. In: CADTH technology review no10. vol. 2018 Sep. Ottawa: CADTH; 2018. 

13.Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S, Koffel E, Khawaja IS, Ouellette J, Butler M et al: AHRQ Comparative Effectiveness Reviews. In: Management of Insomnia Disorder. edn. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015.